Posters

Rejection following deep anterior lamellar keratoplasty

Poster Details

First Author: S.Smitha T INDIA

Co Author(s):    R. Swarup   S. Kotagiri   P. Swarup              

Abstract Details

Purpose:

To assess the pre-operative, intra-operative and post-operative factors related to rejection after Deep Anterior lamellar Keratoplasty(DALK). To assess the types of rejection, duration between DALK and rejection episode, response to therapy and final outcome of rejection after DALK.

Setting:

This retrospective case Study included DALK surgeries performed at a tertiary private referral center between October 2008 and Feb 2018.

Methods:

Case records of a total 412 DALKs performed at the centre were screened for graft rejection. The cases with graft rejection after DALK were studied further to look for pre-operative indications, intra-operative findings and complications, post-operative complications, including details of rejection, management and final outcome.

Results:

11 graft rejections(11eyes of 10patients) were noted. Indication for DALK was keratoconus, except in one eye(corneal opacity post viral infection). Method of DALK was Big-Bubble in 4,Manual dissection technique(Groove and Peel) in rest. Four eyes had intra-operative perforation. Residual stroma was more than 100micron in two. Mean duration of rejection from DALK was 16months (Range 2-33months). Rejection was sub-epithelial in 2, stromal in 9 and in 1eye, combined epithelial-stromal. All rejections resolved with medical therapy leaving clear grafts except 1 where interface vascularisation and lipid keratopathy was noted. 9 of 11eyes had final BSCVA of 6/12 or better.

Conclusions:

Although DALK is not "Rejection-Proof", rejection may be limited to epithelial, sub- epithelial and stromal layers. Rejection post DALK resolves well with timely treatment. Intra-operative perforation, Pre-Descemetic DALK, large diameter DALK may be risk factors for rejection post DALK. Suture related complications post DALK may trigger rejection and stepping up topical steroid may be helpful in such cases.

Financial Disclosure:

None